title: A prognostic model to identify patients with advanced pancreas adenocarcinoma who could benefit from second-line chemotherapy.
abstract: OBJECTIVE
  The role of salvage chemotherapy after first-line therapy in advanced pancreatic cancer has not yet been established. We intended to identify prognostic factors for long-term survival of advanced pancreatic adenocarcinoma patients with second-line chemotherapy and to devise a prognostic model of clinical parameters.
  
  
  METHODS
  We analysed 90 patients who had received second-line chemotherapy after the failure of first-line therapy in recurrent or metastatic pancreatic adenocarcinoma between August 2003 and December 2008.
  
  
  RESULTS
  The median age at the time of second-line chemotherapy was 61.9 years (range 39.8-74.9) and the median Eastern Cooperative Oncology Group (ECOG) performance status was 1 (0-2). Median progression-free survival and overall survival for second-line chemotherapy were 2.1 and 4.5 months, respectively, with an overall response rate of 10%. In multivariate analysis, an ECOG performance status of 2 or more, non-responder for first-line chemotherapy and albumin level of <3.5mg/dl were independent prognostic factors for decreased overall survival for all 90 patients. Overall survival was estimated based on the number of adverse prognostic factors: zero or one (good prognostic group), two (intermediate group) or three (poor prognostic group). The median overall survival for good (n=50), intermediate (n=24) and poor (n=16) prognostic groups was 5.5, 3.3 and 2.1 months, respectively (P<0.001).
  
  
  CONCLUSIONS
  Our result suggests that second-line chemotherapy may be beneficial for overall survival in patients with ECOG performance status 0-1, albumin level ≥3.5mg/dl and response to first-line chemotherapy.
authors.affiliation: Division of Hematology-Oncology, Department of Medicine, Korea University Anam Hospital, Korea University College of Medicine, South Korea.
authors.forename: Seung Tae
authors.initials: ST
authors.lastname: Kim
authors.forename: Yoon Ji
authors.initials: YJ
authors.lastname: Choi
authors.forename: Kyong Hwa
authors.initials: KH
authors.lastname: Park
authors.forename: Sang Cheul
authors.initials: SC
authors.lastname: Oh
authors.forename: Jae Hong
authors.initials: JH
authors.lastname: Seo
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Shin
authors.forename: Jun Suk
authors.initials: JS
authors.lastname: Kim
authors.forename: Yeul Hong
authors.initials: YH
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome